Complication Rates Following Gender-Affirming Hysterectomy in Transgender and Gender-Diverse Patients Compared with Hysterectomy for Benign Conditions

Purpose: The purpose of this study was to compare rates of perioperative complications and health care utilization between transgender and gender-diverse (TGD) patients undergoing gender-affirming hysterectomy (GAH) and patients undergoing hysterectomies for benign indications other than gender dysphoria or incongruence. Methods: We conducted a retrospective cohort study of patients who underwent hysterectomy between January 2016 and December 2023 at a single academic medical center in Wisconsin. All TGD individuals who received a GAH were included. The control group was randomly selected at a 2:1 ratio from a dataset of 3,085 patients who underwent hysterectomy for other benign indications. Data extracted from charts included demographics, parity, surgical indication, estrogen/testosterone use, route of hysterectomy, surgical complications, and postoperative health care utilization. Results: The TGD cohort included 135 individuals, and the comparison cohort included 282 individuals. Intraoperative complications occurred more often in the TGD cohort (13.4% vs. 2.9%, p < 0.001), with perineal or hymenal laceration being the most common. TGD patients were seen more often in the emergency department due to vaginal bleeding compared to the control group (7.5% vs. 2.5%, p = 0.017). There was no difference between the groups in the number of readmissions, reoperations, or unscheduled visits in the postoperative period. Conclusions: TGD patients undergoing GAH experienced higher rates of intraoperative complications and were more frequently seen in the emergency department for postoperative vaginal bleeding compared to patients undergoing hysterectomy for benign indications. However, most intraoperative complications in the TGD cohort were minor. Further investigation is needed regarding preoperative counseling about expected postoperative symptoms.